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Distribution and characteristics of bacteria on the hand during oropharyngeal swab collection: Which handwashing points are affected?

Abstract

Aims

To identify the contaminated areas of the hand collection and analyse the distribution characteristics of bacteria in the hand after swab collection.

Design

This study used a cross-sectional design.

Methods

A cross-sectional study sampling 50 pairs of hands (sampling hand and auxiliary hand) of healthcare workers was performed. Ten samples were collected from each participant. The optimal hand hygiene rates and bacterial colony counts of the whole hand and different hand sections without hand hygiene were identified as the primary outcomes.

Results

The optimal hand hygiene rates of the sampling hand and auxiliary hand were 88.8% (222/250) and 91.6% (229/250), respectively. The lowest optimal hand hygiene rates for the sampling hand and the auxiliary hand were both on the dorsal side of the finger and the dorsum of the hand (86.0%, 86.0% vs. 90.0%, 86.0%); the optimal hand hygiene rates for both sites of the sampling hand were 86.0% (43/50), and the optimal hand hygiene rates for the auxiliary hand were 90.0% (45/50) and 86.0% (43/50). The bacteria colony counts did not differ between the sampling hands and auxiliary hand.

Conclusions

The dorsal side of the finger and dorsum of the hand were the most likely to be contaminated during oropharyngeal swab collection. Therefore, it is essential to pay extra attention to hand hygiene care of these two sites during the collection process to minimize the risk of cross-contamination.

Reporting Method

The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines were adopted in this study.

Depression and anxiety among nurses during the COVID‐19 pandemic: Longitudinal results over 2 years from the multicentre VOICE–EgePan study

Abstract

Aims

To examine symptoms of depression and generalised anxiety among nurses over 2 years during the pandemic and compare them to the general population.

Background

The COVID-19 pandemic has led to a significant increase in mental stress among the population worldwide. Nursing staff have been identified as being under remarkable strain.

Design

A multicentre prospective longitudinal study.

Methods

Symptoms of depression and generalised anxiety in 507 nurses were examined at four different time points (T1: April–July 2020, T2: November 2020–January 2021, T3: May–July 2021, T4: February–May 2022). Results were compared with values of the German general population, presence of gender-specific differences was analysed and frequencies of clinically relevant levels of depression and anxiety were determined.

Results

Throughout the study (T1–T4), a significant increase in depressive and anxiety symptoms was observed. At all four measurement time points, nurses showed significantly higher prevalence for depression and anxiety compared to the German general population. No significant gender differences were found. Frequencies for probable depression and generalised anxiety disorder among nurses were: 21.6% and 18.5% (T1), 31.4% and 29.2% (T2), 29.5% and 26.2% (T3), 33.7% and 26.4% (T4).

Conclusion

During the pandemic, symptoms of depression and generalised anxiety among nurses increased significantly and remained elevated. Their symptom levels were permanently higher than in the general population. These findings strongly suggest that the circumstances of the pandemic severely affected nurses´ mental health.

Relevance to Clinical Practice

The COVID-19 pandemic caused a great mental strain on caregivers. This study was able to demonstrate the significant increase in depression and anxiety among nurses during the pandemic. It highlights the urgent need for prevention, screening and support systems in hospitals.

Implications for the Profession

Supportive programmes and preventive services should be developed, not least to prevent the growing shortage of nurses in the health care systems.

Reporting Method

The study adhered to relevant EQUATOR guidelines. The STROBE checklist for cohort study was used as the reporting method.

Patient Contribution

Five hundred and seven nurses completed the questionnaire and provided data for analysis.

Trial and Protocol Registration

The study was registered with the German Clinical Trials Register (https://drks.de/search/en) under the following ID: DRKS00021268.

The effectiveness of brief reminiscence‐based psychosocial interventions for cancer patients: A systematic review and meta‐analysis

Abstract

Aim

To determine the effectiveness of brief reminiscence-based psychosocial interventions in alleviating psychological distress in cancer patients.

Background

Cancer patients suffer tremendous psycho-spiritual pain, which affects their quality of life. Brief reminiscence-based psychosocial interventions have demonstrated positive effects on the mental health of cancer patients; however, the efficacy of these interventions has been inconsistent.

Design

A systematic review and meta-analysis.

Methods

This review was conducted and reported in accordance with the PRISMA 2020 checklist provided by the EQUATOR network. The Cochrane Library, Web of Science, PsycINFO, PubMed, Embase, CINAHL and Scopus databases were systematically searched from inception to 27 November 2022 to identify randomised controlled trials (RCTs) published in English.

Results

Twenty studies involving 1744 cancer participants were included. The meta-analysis showed statistically significant effects of brief reminiscence-based psychosocial interventions on hope, anxiety and depression at post-intervention. A separate analysis revealed that brief reminiscence-based psychosocial interventions had a sustainable effect on hope, spiritual well-being, anxiety and depression at 1 month after the intervention. However, no statistically significant effect on quality of life was found in our study either immediately after the intervention or at 1 month.

Conclusions

Brief reminiscence-based psychosocial interventions can significantly reduce anxiety and depressive symptoms and improve hope and spiritual well-being in cancer patients.

Relevance to Clinical Practice

This study further supports that brief reminiscence-based psychosocial interventions should be incorporated into the routine care of cancer patients to address their psychosocial distress.

Patient or Public Contribution

All authors of this article contributed to the study conception and design. All authors of the included studies provided original data for this paper.

Sustainable employability of long‐term care staff in self‐managing teams: A qualitative study

Abstract

Aim

To discover what long-term care (LTC) staff working in self-managing teams consider necessary to remain sustainably employable.

Design

Qualitative study with semi-structured interviews.

Methods

In 2020, semi-structured interviews were conducted one-on-one with 25 LTC workers from a medium-large Dutch organization providing long-term care. All interviews were audio-recorded, anonymously transcribed verbatim and analysed with thematic content analysis in the software program Atlas.ti.

Results

LTC workers indicated a need for autonomy. They wanted their control and involvement in decisions to be strengthened. Furthermore, LTC workers indicated a need for relatedness, by experiencing support, a feeling of togetherness and more time to have attention for the residents. Lastly, LTC workers expressed a need for (assistance in) further developing their competence.

Conclusion

In order to remain willing and able to work, LTC workers in self-managing teams want their needs for autonomy, relatedness and competence to be addressed. Working conditions are important to these LTC workers' sustainable employability since they can hinder or promote the satisfaction of their needs.

Implications

It is important that management in LTC is aware of the importance of LTC workers' needs for sustainable employability. We recommend that management critically reflect on and invest in addressing these needs by enhancing indicators and limiting inhibitors of the needs.

Impact

A robust LTC workforce is necessary to provide care to the aging population. In the context of the increasing implementation of self-managing teams in LTC organizations, understanding what workers in self-managing teams need in order to remain sustainably employable is crucial. For sustainable employability (i.e. to remain willing and able to work), interviewees indicated a need for autonomy, relatedness, and competence. Nearly all participants stressed the importance of belonging and feeling connected. Working conditions seemed to relate not only directly to the sustainable employability of LTC staff but also indirectly through their lack of contribution to the satisfaction of workers' psychological needs. The outcomes of this study primarily impact workers and management within LTC organizations with self-managing teams. They benefit from recognizing the significance of addressing workers' needs to ensure their essential and sustainable employability in the sector.

Reporting Method

The Standards for Reporting Qualitative Research and the Consolidated Criteria for Reporting Qualitative (COREQ) research were used.

Patient or Public Contribution

Two LTC workers provided advice and feedback regarding the materials and set up of the interviews. These two ambassadors additionally helped in reaching our population, by disseminating information about the study.

Associations between hospital organizational features, person‐centred care and nurse‐sensitive outcomes for persons with dementia in acute care: A systematic literature review

Abstract

Aim(s)

The aim of this systematic literature review was to determine the extent and quality of quantitative evidence regarding associations between hospital organizational features, person-centred care (PCC) and nursing-sensitive outcomes among persons with dementia in the acute care setting.

Design

Systematic review.

Methods

Key terms were utilized to guide searches in four databases. The two reviewers deduplicated articles and came to a consensus for the final sample using inclusion and exclusion criteria.

Data Sources

MEDLINE/OVID, CINHAL, COCHRANE and WEB OF SCIENCE.

Results

There were 10 studies included. PCC was associated with better outcomes for persons with dementia (i.e. decreased restraint use, decreased length of stay, increased involvement with families and the patient, and increased nurse confidence and competence in caring for this population). Of the studies, none explicitly identified an association between nursing-sensitive outcomes, PCC and hospital organizational features in the acute care setting among persons with dementia.

Conclusion

This review highlights a clinically significant gap in knowledge regarding associations between hospital organizational features, PCC and nursing sensitive outcomes. The impact of face-to-face dementia competency training as a standard practice among acute care facilities, the importance of leadership engagement, support and involvement to improve nurse confidence and competence in caring for persons with dementia needs to be explored.

Impact Statement

These findings support future research to understand the relationship between organization features and patient-centred care and how these collectively impact nursing-sensitive outcomes, specifically in persons with dementia in acute care settings.

Being effective and supervising for thesis success in nursing coursework master degrees: A qualitative descriptive study

Abstract

Background

Master's degrees for nurses have various foci including clinical practice, leadership and education, with some programs consisting of coursework, while others offer hybrid study that combines coursework and research. Multiple formats are associated with offering the research component. The research component is often termed the minor thesis. Limited knowledge exists regarding the supervision of the research component.

Aim(s)

To capture the practices and perspectives of experienced nurse academics regarding effective supervision of the masters-level minor thesis in nursing coursework master degrees.

The Study

Design

Qualitative descriptive.

Methods

Semi-structured interviews with 28 experienced nurse academics recruited from 15 Australian and three New Zealand universities linked to the Council of Deans in Australia and New Zealand. Inclusion criteria were having experience of supervising masters-level minor theses and higher degrees. Interviews were face-to-face using the internet platform Zoom©. Thematic analysis was undertaken.

Findings

The analysis revealed three themes and associated sub-themes: (i) establishing the framework (setting up the student's research; building the student–supervisor relationship; setting clear expectations), (ii) supervisors' knowledge and actions: driving for success (supervisors' knowledge for a satisfactory and timely outcome; supervisors' actions to develop students' capabilities; supervisors' actions of drawing in other expertise) and (iii) supervisor savviness: Attending to the finer points of supervision for student success (using your attributes as a supervisor; being savvy to teach and engage students; creatively seeking a smooth process for student success).

Conclusion

The findings highlight three themes crucial to effective supervision of masters-level minor theses in nursing: Establishing a strong research framework, emphasizing supervisors' knowledge and proactive engagement and attending to nuanced aspects of supervision for student success. These insights contribute to deeper understanding of the multifaceted nature of supervising minor theses, providing a valuable foundation for refining supervisory practices and enhancing the educational experience within coursework nursing master degree programs.

Implications for the Profession and/or Patient Care

The findings highlight the supervisors' pivotal practices in guiding students through the minor thesis. These insights will be useful for inexperienced and experienced supervisors and for degree program directors. The findings should inform supervision training and supervision practices in the future.

Impact

The study addressed a gap in knowledge about what experienced supervisors do to be effective and achieve success in the research component in a hybrid master degree for registered nurses. Effective supervision for student success in the minor thesis requires supervisors to establish and maintain a project and supervisory framework with appropriate boundaries and that is attuned to both the supervisor and student capabilities and preferences. Supervisors have an active role in directing the focus, scale and scope of a minor theses in keeping with university requirements and the short timeframe. Supervisors pay attention to the development of multiple student literacies (research, academic, professional, feedback and cultural) as core aspects of the masters research journey. Supervisors use their savviness and customize supervision to student contexts and capabilities as they guide development to achieve student success. The research findings have implications for targeted supervisor training and enhancing educational strategies for research supervision of minor thesis students.

Reporting Method

COREQ reporting was adhered to as the relevant EQUATOR guideline.

Patient or Public Contribution

No patient or public contribution.

Nurses' use of an advisory decision support system in ambulance services: A qualitative study

Abstract

Aim

To illuminate from the perspective of nurses in ambulance services the experiences of using a web-based advisory decision support system to assess care needs and refer patients.

Design

Inductive and descriptive approaches.

Method

Thirteen semi-structured interviews were conducted in the spring of 2020. The data were analysed through the reflexive thematic analysis.

Results

The Swedish web-based advisory decision support system (ADSS) was found to strengthen nurses' feelings of security when they assess patients' care needs, promote their competence and professional pride, and help them manage stress. However, the system also generated difficulties for nurses to adjust to the dynamic ambulance team and revealed a discrepancy between their professional roles and responsibilities to refer patients and provide self-care advice. The nurses thought that the support system facilitated their increased participation and helped them understand patients and significant others by offering transparency in assessment and decision making. Thus, the support system provides nurses with an opportunity to strengthen patients' independence through information and education. However, in the care relationship, nurses worked to overcome patients' expectations.

Conclusion

Nurses using the ADSS increased their security while performing assessments and referrals and found new opportunities to provide information and promote understanding of their decisions. However, nursing care values can be threatened when new support systems are introduced, especially as ambulance services become increasingly protocol-driven.

Implications for Profession and/or Patient Care

These findings have implications for nurses' work environments and help them maintain consistency in making medical assessments and in providing equivalent self-care advice when referring patients to the different levels of care. The findings will also impact researchers and policymakers who formulate decision support systems.

Reporting Method

Consolidated criteria for reporting qualitative research (COREQ).

Patient or Public Contribution

None.

Nurses' use of ‘wellness’ supplements during the COVID‐19 pandemic in the United States

Abstract

Aim

Quantify disparities and identify correlates and predictors of ‘wellness’ supplement use among nurses during the first year of the pandemic.

Design

Longitudinal secondary analysis of Nurses' Health Studies 2 and 3 and Growing Up Today Study data.

Methods

Sample included 36,518 total participants, 12,044 of which were nurses, who completed surveys during the first year of the COVID-19 pandemic (April 2020 to April 2021). Analyses were conducted in March 2023. Modified Poisson models were used to estimate disparities in ‘wellness’ supplement use between nurses and non-healthcare workers and, among nurses only, to quantify associations with workplace-related predictors (occupational discrimination, PPE access, workplace setting) and psychosocial predictors (depression/anxiety, county-level COVID-19 mortality). Models included race/ethnicity, gender identity, age and cohort as covariates.

Results

Nurses were significantly more likely to use all types of supplements than non-healthcare workers. Lacking personal protective equipment and experiencing occupational discrimination were significantly associated with new immune supplement use. Depression increased the risk of using weight loss, energy and immune supplements.

Conclusion

Nurses' disproportionate use of ‘wellness’ supplements during the COVID-19 pandemic may be related to workplace and psychosocial stressors. Given well-documented risks of harm from the use of ‘wellness’ supplements, the use of these products by nurses is of concern.

Impact

‘Wellness’ supplements promoting weight loss, increased energy, boosted immunity and cleansing of organs are omnipresent in today's health-focused culture, though their use has been associated with harm. This is of added concern among nurses given their risk of COVID-19 infection at work. Our study highlighted the risk factors associated with use of these products (lacking PPE and experiencing occupational discrimination). Findings support prior research suggesting a need for greater public health policy and education around the use of ‘wellness’ supplements.

Reporting Method

STROBE guidelines were followed throughout manuscript.

Patient or Public Contribution

No patient or public contribution was involved.

The prevalence of incivility in hospitals and the effects of incivility on patient safety culture and outcomes: A systematic review and meta‐analysis

Abstract

Aim

Workplace incivility is a barrier to safe and high-quality patient care in nursing workplaces and more broadly in tertiary hospitals. The present study aims to systematically review the existing evidence to provide a comprehensive understanding of the prevalence of co-worker incivility experienced and witnessed by nurses and other healthcare professionals, the effects of incivility on patient safety culture (PSC) and patient outcomes, and the factors which mediate the relationship between incivility and patient safety.

Methods

A systematic review with narrative synthesis and meta-analysis was undertaken to synthesize the data from 41 studies.

Data Sources

Databases searched included MEDLINE, PubMed, SCOPUS, CINAHL, PsycInfo, ProQuest, Emcare and Embase. Searches were conducted on 17 August 2021 and repeated on 15 March 2023.

Results

The pooled prevalence of experienced incivility was 25.0%. The pooled prevalence of witnessed incivility was 30.1%. Workplace incivility was negatively associated with the PSC domains of teamwork, reporting patient safety events, organization learning/improvement, management support for safety, leadership, communication openness and communication about error. The composite pooled effect size of incivility on these domains of PSC was OR = 0.590, 95% CI [0.515, 0.676]. Workplace incivility was associated with a range of patient safety outcomes (PSOs) including near misses, adverse events, reduced procedural and diagnostic performance, medical error and mortality. State depletion, profession, psychological responses to incivility, information sharing, help seeking, workload and satisfaction with organizational communication were found to mediate the relationship between incivility and patient safety.

Conclusion

Experienced and witnessed incivility is prevalent in tertiary hospitals and has a deleterious effect on PSC and PSOs. A better understanding of the mechanisms of this relationship will support the development of interventions aimed at reducing both incivility and patient harm.

Implications for the Profession and/or Patient Care Impact

This study quantifies the effect of incivility on PSC and outcomes. It provides support that interventions focusing on incivility are a valuable mechanism for improving patient care. It guides intervention design by highlighting which domains of PSC are most associated with incivility. It explores the profession-specific experiences of workplace incivility.

Reporting Method

This report adheres to PRISMA reporting guidelines.

Patient or Public Contribution

No patient or public contribution. The focus of this study is the nursing and healthcare workforce, therefore, patient or public involvement not required.

Racial/ethnic disparities in sleep health among adolescents in South Korea: The role of substance use behaviours

Abstract

Aim

To examine the relationship between racial/ethnic disparities and substance use behaviours (alcohol and tobacco use) and their impact on the sleep health of South Korean adolescents.

Design

Secondary analysis of cross-sectional study data from the 2021 Korea Youth Risk Behaviour Web-based Survey dataset.

Methods

Given that Korean society has historically linked its racial/ethnic identity to a shared bloodline, we categorized 2644 adolescents from the Korea Youth Risk Behaviour Web-based Survey based on their racial/ethnic status, determined by their parents' birthplaces. Using multiple linear regression, we investigated whether the impact of racial/ethnic disparities on sleep health (sleep duration, debt, and timing) varies depending on substance use behaviours (alcohol and tobacco use) after controlling for age, sex, household economic status, depressed mood, suicidal ideation, perceived excessive stress, and anxiety level.

Results

Despite no statistical differences in sleep health and the prevalence of substance use between racial/ethnic groups, racial/ethnic minority adolescents experienced greater sleep debt than racial/ethnic majority adolescents when consuming alcohol. Moreover, racial/ethnic minority adolescents were more likely to report psychosocial distress and had lower parental education level.

Conclusion

Racial/ethnic minority adolescents were more vulnerable to the detrimental effects of alcohol use on sleep health compared to racial/ethnic majority adolescents. This heightened vulnerability may be attributed to the more pronounced psychosocial challenges and the lower socioeconomic status of parents in the racial/ethnic minority group.

Impact

Racial/ethnic disparities are concerning in South Korea, particularly since the negative effects of substance use on sleep health are intensified among racial/ethnic minority adolescents. Nurses and other healthcare providers should recognize the importance of addressing the social disadvantages linked to racial/ethnic disparities. Beyond just advocating for the cessation of substance use, it is crucial to address these underlying issues to reduce sleep disparities among South Korean adolescents.

Patient or Public Contribution

No patient or public contribution.

Integrating genomics into Canadian oncology nursing policy: Insights from a comparative policy analysis

Abstract

Aim

To learn from two jurisdictions with mature genomics-informed nursing policy infrastructure—the United States (US) and the United Kingdom (UK)—to inform policy development for genomics-informed oncology nursing practice and education in Canada.

Design

Comparative document and policy analysis drawing on the 3i + E framework.

Methods

We drew on the principles of a rapid review and identified academic literature, grey literature and nursing policy documents through a systematic search of two databases, a website search of national genomics nursing and oncology nursing organizations in the US and UK, and recommendations from subject matter experts on an international advisory committee. A total of 94 documents informed our analysis.

Results

We found several types of policy documents guiding genomics-informed nursing practice and education in the US and UK. These included position statements, policy advocacy briefs, competencies, scope and standards of practice and education and curriculum frameworks. Examples of drivers that influenced policy development included nurses' values in aligning with evidence and meeting public expectations, strong nurse leaders, policy networks and shifting healthcare and policy landscapes.

Conclusion

Our analysis of nursing policy infrastructure in the US and UK provides a framework to guide policy recommendations to accelerate the integration of genomics into Canadian oncology nursing practice and education.

Implications for the profession

Findings can assist Canadian oncology nurses in developing nursing policy infrastructure that supports full participation in safe and equitable genomics-informed oncology nursing practice and education within an interprofessional context.

Impact

This study informs Canadian policy development for genomics-informed oncology nursing education and practice. The experiences of other countries demonstrate that change is incremental, and investment from strong advocates and collaborators can accelerate the integration of genomics into nursing. Though this research focuses on oncology nursing, it may also inform other nursing practice contexts influenced by genomics.

Trends in publication impact of evidence‐based healthcare terminology (2013–2022)

Abstract

Aims

This article explored the publication impact of evidence-based healthcare terminology to determine usage and discuss options for low usage terms.

Background

A plethora of terms describe the scholarship of evidence-based healthcare. Several terms are synonyms, creating redundancy and confusion. The abundance and overlap of terms may impede the discovery of evidence.

Design

This discursive article explored and discussed publication impact of evidence-based healthcare terms.

Methods

Evidence-based healthcare terms were identified, and their 10-year (2013–2022) publication impact was assessed in the CINAHL and Medline databases. A card sort method was also used to identify terms with low usage.

Results

A total of 18/32 terms were included in the review. The terms evidence-based practice, quality improvement, research and translational research were the most highly published terms. Publication data were presented yearly over a 10-year period. Most terms increased in publication use over time, except for three terms whose use decreased. Several terms related to translational research have multiple synonyms. It remains unknown whether these terms are interchangeable and possibly redundant, or if there are nuanced differences between terms.

Conclusion

We suggest a follow-up review in 3–5 years to identify publication trends to assess context and terms with continued low publication usage. Terms with persistent low usage should be considered for retirement in the reporting of scholarly activities. Additionally, terms with increasing publication trends should be treated as emerging terms that contribute to evidence-based healthcare terminology.

Implications for Nursing

Confusion about the use of appropriate terminology may hinder progress in the scholarship of evidence-based healthcare. We encourage scholars to be aware of publication impact as it relates to the use of specific terminology and be purposeful in the selection of terms used in scholarly projects and publications.

The perceived helpfulness and acceptability of a bespoke psychological therapy service for registered nurses experiencing psychological distress: A qualitative study

Abstract

Aim

To understand the perceived helpfulness and acceptability of a bespoke psychological therapy service for registered nurses. The service provided a free and confidential specialist mental health service to all healthcare professionals, including nurses and nursing students.

Design

An exploratory study using a descriptive qualitative approach.

Methods

A purposive sample of 20 registered nurses accessing a bespoke psychological therapy service in Wales participated in audio-recorded semi-structured interviews in January 2022. Transcribed data were analysed using reflexive thematic analysis.

Results

Four interrelated themes were identified from the data analysis: COVID [SARS-CoV-2] changed things; You're a nurse, you're human; I've got ‘me’ back; and pretty close to miracle workers.

Conclusion

Participants attempted to live up to an idealized image of a nurse, generating self-stigmatizing beliefs that negatively affected their mental health. The psychological therapy service enabled participants to put their roles into perspective, that is, separate themselves from their role, be vulnerable, and develop confidence and adaptive coping strategies. Participants valued the minimal barriers and ease of access to support.

Implications for the Profession and/or Patient Care

The complex relationship between nurse identity and the challenges of the workplace needs to be central to nurse education. Nurses can benefit from rapid access to a timely, confidential, and independent self-referring psychological therapy service.

Impact

This qualitative study explored the helpfulness and accessibility of psychological support for nurses. The main themes were that COVID changed things; You're a nurse, you're human; I've got ‘me’ back; and pretty close to miracle workers. The findings will impact how nurses are supported in the United Kingdom and worldwide.

Reporting Method

This report adheres to the standards for reporting qualitative research (SRQR).

Patient or Public Contribution

No patient or public contribution.

Assessing the accuracy of health facility typology in representing the availability of health services: a case study in Mali

Por: Petragallo · S. · Timoner · P. · Hierink · F. · Fuhrer · C. · Toure · O. · Iknane · A. · Coulibaly · Y. · Fall · I.-S. · Ray · N.
Introduction

Using health facility types as a measure of service availability is a common approach in international standards for health system policy and planning. However, this proxy may not accurately reflect the actual availability of specific health services.

Objective

This study aims to evaluate the reliability of health facility typology as an indicator of specific health service availability and explore whether certain facility types consistently provide particular services.

Design

We analysed a comprehensive dataset containing information from 1725 health facilities in Mali. To uncover and visualise patterns within the dataset, we used two analytical techniques: Multiple Correspondence Analysis and Between-Class Analysis. These analyses allowed us to quantitatively measure the influence of health facility types on the variation in health service provisioning. Additionally, we developed and calculated a Consistency Index, which assesses the consistency of a health facility type in providing specific health services. By examining various health facilities and services, we sought to determine the accuracy of facility types as indicators of service availability.

Setting

The study focused on the health system in Mali as a case study.

Results

Our findings indicate that using health facility types as a proxy for service availability in Mali is not an accurate representation. We observed that most of the variation in service provision does not stem from differences between facility types but rather within facility types. This suggests that relying solely on health facility typology may lead to an incomplete understanding of health service availability.

Conclusions

These results have significant implications for health policy and planning. The reliance on health facility types as indicators for health system policy and planning should be reconsidered. A more nuanced and evidence-based understanding of health service availability is crucial for effective health policy and planning, as well as for the assessment and monitoring of health systems.

Evidence for clinician underprescription of and patient non-adherence to guideline-recommended cardiovascular medications among adults with peripheral artery disease: protocol for a systematic review and meta-analysis

Por: de Launay · D. · Paquet · M. · Kirkham · A. M. · Graham · I. D. · Fergusson · D. A. · Nagpal · S. K. · Shorr · R. · Grimshaw · J. M. · Roberts · D. J.
Introduction

International guidelines recommend that adults with peripheral artery disease (PAD) be prescribed antiplatelet, statin and antihypertensive medications. However, it is unclear how often people with PAD are underprescribed these drugs, which characteristics predict clinician underprescription of and patient non-adherence to guideline-recommended cardiovascular medications, and whether underprescription and non-adherence are associated with adverse health and health system outcomes.

Methods and analysis

We will search MEDLINE, EMBASE and Evidence-Based Medicine Reviews from 2006 onwards. Two investigators will independently review abstracts and full-text studies. We will include studies that enrolled adults and reported the incidence and/or prevalence of clinician underprescription of or patient non-adherence to guideline-recommended cardiovascular medications among people with PAD; adjusted risk factors for underprescription of/non-adherence to these medications; and adjusted associations between underprescription/non-adherence to these medications and outcomes. Outcomes will include mortality, major adverse cardiac and limb events (including revascularisation procedures and amputations), other reported morbidities, healthcare resource use and costs. Two investigators will independently extract data and evaluate study risk of bias. We will calculate summary estimates of the incidence and prevalence of clinician underprescription/patient non-adherence across studies. We will also conduct subgroup meta-analyses and meta-regression to determine if estimates vary by country, characteristics of the patients and treating clinicians, population-based versus non-population-based design, and study risks of bias. Finally, we will calculate pooled adjusted risk factors for underprescription/non-adherence and adjusted associations between underprescription/non-adherence and outcomes. We will use Grading of Recommendations, Assessment, Development and Evaluation to determine estimate certainty.

Ethics and dissemination

Ethics approval is not required as we are studying published data. This systematic review will synthesise existing evidence regarding clinician underprescription of and patient non-adherence to guideline-recommended cardiovascular medications in adults with PAD. Results will be used to identify evidence-care gaps and inform where interventions may be required to improve clinician prescribing and patient adherence to prescribed medications.

PROSPERO registration number

CRD42022362801.

Pancreatic quantitative sensory testing to predict treatment response of endoscopic therapy or surgery for painful chronic pancreatitis with pancreatic duct obstruction: study protocol for an observational clinical trial

Por: Phillips · A. E. · Afghani · E. · Akshintala · V. S. · Benos · P. Y. · Das · R. · Drewes · A. M. · Easler · J. · Faghih · M. · Gabbert · C. · Halappa · V. · Khashab · M. A. · Olesen · S. S. · Saloman · J. L. · Sholosh · B. · Slivka · A. · Wang · T. · Yadav · D. · Singh · V. K.
Introduction

Treatment for abdominal pain in patients with chronic pancreatitis (CP) remains challenging in the setting of central nervous system sensitisation, a phenomenon of remodelling and neuronal hyperexcitability resulting from persistent pain stimuli. This is suspected to render affected individuals less likely to respond to conventional therapies. Endotherapy or surgical decompression is offered to patients with pancreatic duct obstruction. However, the response to treatment is unpredictable. Pancreatic quantitative sensory testing (P-QST), an investigative technique of standardised stimulations to test the pain system in CP, has been used for phenotyping patients into three mutually exclusive groups: no central sensitisation, segmental sensitisation (pancreatic viscerotome) and widespread hyperalgesia suggestive of supraspinal central sensitisation. We will test the predictive capability of the pretreatment P-QST phenotype to predict the likelihood of pain improvement following invasive treatment for painful CP.

Methods and analysis

This observational clinical trial will enrol 150 patients from the University of Pittsburgh, Johns Hopkins and Indiana University. Participants will undergo pretreatment phenotyping with P-QST. Treatment will be pancreatic endotherapy or surgery for clearance of painful pancreatic duct obstruction. Primary outcome: average pain score over the preceding 7 days measured by Numeric Rating Scale at 6 months postintervention. Secondary outcomes will include changes in opioid use during follow-up, and patient-reported outcomes in pain and quality of life at 3, 6 and 12 months after the intervention. Exploratory outcomes will include creation of a model for individualised prediction of response to invasive treatment.

Ethics and dissemination

The trial will evaluate the ability of P-QST to predict response to invasive treatment for painful CP and develop a predictive model for individualised prediction of treatment response for widespread use. This trial was approved by the University of Pittsburgh Institutional Review Board. Data and results will be reported and disseminated in conjunction with National Institutes of Health policies.

Trial registration number

NCT04996628.

Protocol for a scoping review of factors associated with disparities in clinical provision of deep brain stimulation

Por: Abramson · T. · Aguero · R. · Arizpe · A. · Frank · A. · Kang · S. · Mason · X.
Introduction

Deep brain stimulation (DBS) can be used to treat several neurological and psychiatric conditions such as Parkinson’s disease, epilepsy and obsessive-compulsive disorder; however, limited work has been done to assess the disparities in DBS access and implementation. The goal of this scoping review is to identify sources of disparity in the clinical provision of DBS.

Methods and analysis

A scoping review will be conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-extension for Scoping Reviews methodology. Relevant studies will be identified from databases including MEDLINE/PubMed, EMBASE and Web of Science, as well as reference lists from retained articles. Initial search dates were in January 2023, with the study still ongoing. An initial screening of the titles and abstracts of potentially eligible studies will be completed, with relevant studies collected for full-text review. The principal investigators and coauthors will then independently review all full-text articles meeting the inclusion criteria. Data will be extracted and collected in table format. Finally, results will be synthesised in a table and narrative report.

Ethics and dissemination

No institutional board review or approval is necessary for the proposed scoping review. The findings will be submitted for publication to relevant peer-reviewed journals and conferences.

Scoping review registration

This protocol has been registered prospectively on the Open Science Framework (https://osf.io/cxvhu).

Using the Power Wheel as a transformative tool to promote equity through spaces and places of patient engagement

Por: Sayani · A. · Cordeaux · E. · Wu · K. · Awil · F. · Garcia · V. · Hinds · R. · Jeji · T. · Khan · O. · Soh · B.-L. · Mensah · D. · Monteith · L. · Musawi · M. · Rathbone · M. · Robinson · J. · Sterling · S. · Wardak · D. · Amsdr · I. · Khawari · M. · Niwe · S. · Hussain · A. · Forster · V. · May
Background

Patient engagement is the active collaboration between patient partners and health system partners towards a goal of making decisions that centre patient needs—thus improving experiences of care, and overall effectiveness of health services in alignment with the Quintuple Aim. An important but challenging aspect of patient engagement is including diverse perspectives particularly those experiencing health inequities. When such populations are excluded from decision-making in health policy, practice and research, we risk creating a healthcare ecosystem that reinforces structural marginalisation and perpetuates health inequities.

Approach

Despite the growing body of literature on knowledge coproduction, few have addressed the role of power relations in patient engagement and offered actionable steps for engaging diverse patients in an inclusive way with a goal of improving health equity. To fill this knowledge gap, we draw on theoretical concepts of power, our own experience codesigning a novel model of patient engagement that is equity promoting, Equity Mobilizing Partnerships in Community, and extensive experience as patient partners engaged across the healthcare ecosystem. We introduce readers to a new conceptual tool, the Power Wheel, that can be used to analyse the interspersion of power in the places and spaces of patient engagement.

Conclusion

As a tool for ongoing praxis (reflection +action), the Power Wheel can be used to report, reflect and resolve power asymmetries in patient-partnered projects, thereby increasing transparency and illuminating opportunities for equitable transformation and social inclusion so that health services can meet the needs and priorities of all people.

Examining the relationship between the oral microbiome, alcohol intake and alcohol-comorbid neuropsychological disorders: protocol for a scoping review

Por: Maki · K. A. · Crayton · C. B. · Butera · G. · Wallen · G. R.
Introduction

Heavy alcohol use and alcohol use disorder (AUD) continues to rise as a public health problem and increases the risk for disease. Elevated rates of anxiety, depression, sleep disruption and stress are associated with alcohol use. Symptoms may progress to diagnosed neurophysiological conditions and increase risk for relapse if abstinence is attempted. Research on mechanisms connecting the gastrointestinal microbiome to neuropsychological disorders through the gut-brain axis is well-established. Less is known how the oral microbiome and oral microbial-associated biomarkers may signal to the brain. Therefore, a synthesis of research studying relationships between alcohol intake, alcohol-associated neurophysiological symptoms and the oral microbiome is needed to understand the state of the current science. In this paper, we outline our protocol to collect, evaluate and synthesise research focused on associations between alcohol intake and AUD-related neuropsychological disorders with the oral microbiome.

Methods and analysis

The search strategy was developed and will be executed in collaboration with a medical research librarian. Studies will be screened by two independent investigators according to the aim of the scoping review, along with the outlined exclusion and inclusion criteria. After screening, data will be extracted and synthesised from the included papers according to predefined demographic, clinical and microbiome methodology metrics.

Ethics and dissemination

A scoping review of primary sources is needed to synthesise the data on relationships between alcohol use, neuropsychological conditions associated with AUD and the oral microbiome. The proposed scoping review is based on the data from publicly available databases and does not require ethical approval. We expect the results of this synthesis will identify gaps in the growing literature and highlight potential mechanisms linking the oral-brain axis to addiction and other associated neuropsychological conditions. The study findings and results will be disseminated through journals and conferences related to psychology, neuroscience, dentistry and the microbiome.

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